The long-term objective of our program of research is to improve the cardiovascular (CV) health of inmates by implementation of a state-wide CV risk factor reduction program in prisons. The purpose of the proposed study in male inmates is to test the effects of a behavioral CV risk reduction (BCVRR) intervention on health outcomes (i.e., Cooper Clinic Mortality Risk Index [a composite index that includes heart rate, blood pressure, diabetes, smoking status, body mass index, age, and cardio-respiratory fitness], lipid profile, and modifiable lifestyle behaviors) in 4 Kentucky Department of Corrections (KyDOC) state-run prisons. This study will be conducted in 4 state operated prisons. A multiple baselines, repeated measures design will be used in which all participants receive the intervention, and all have a 3 month run-in period in which to establish their own baseline without intervention. This type of design is ideal in the prison environment where it is not possible to randomly assign inmates to a control group. We will enroll 560 inmates to reach our goal of 400 who finish the program, as a drop-out rate of 30% is expected based on existing literature and our prior work. At each prison, data will be gathered from inmates at four time points (run-in baseline, pre-intervention baseline, immediately post-intervention and 3 months post-intervention). The BCVRR intervention is a 12-week CV health education/behavior change, and aerobic physical training program, consisting of: 1) health education with behavior change strategies session delivered by certified health educators and other trained professionals from the community;and 2) an aerobic exercise program led by CV risk reduction trainers. Short and long-term effects will be measured immediately after the 12-week intervention and 3 months after the intervention ends. Specific Aim 1: To determine the impact of the BCVRR intervention on CV risk factor reduction (i.e., the total Cooper Clinic Mortality Risk Index [CCMRI], individual modifiable components of the CCMRI, HgA1c in diabetics, and lipid profile) Hypothesis 1: There will be a significant decline in total CCMRI and improvement in the individual modifiable components of the CCMRI and an improved HgA1c for diabetics, and improved lipid profile over time following the intervention, compared with the run-in and pre-intervention baseline for each outcome. Specific Aim 2: To determine the impact of the intervention on the self-report of modifiable lifestyle behaviors (i.e., Inmate Health Risk Assessment). Hypothesis 2: There will be a significant improvement in self-reported modifiable lifestyle behaviors compared with the run-in and pre-intervention baseline for each outcome. Specific Aim 3: To generate data from the proposed study for a proposal for state-wide testing and implementation of the intervention at all of the 13 KyDOC state-run prisons in order to sustain the program. PUBLIC HEALTH RELEVANCE: Narrative Cardiovascular disease is the main cause of death in rison and inmates have disproportionately higher rates of cardiovascular risk factors. The objective of our program of research is to improve the cardiovascular health of inmates by implementation of a cardiovascular risk factor reduction program in prisons. Effective management of cardiovascular risk factors could improve the health of inmates both while incarcerated and once released, and reduce the substantial personal and societal burden of cardiovascular disease.